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NPI Code Detail

MEDICARE: MRS. KIMBERLY T PROCTOR-WHITE NCC, TLPC-MHSP

MEDICARE: MRS. KIMBERLY T PROCTOR-WHITE NCC, TLPC-MHSP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1518778240
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KIMBERLY T PROCTOR-WHITE NCC, TLPC-MHSP
Provider Business Mailing Address
First Line : 521 STONECREST PKWY STE 102
Second Line :
City : SMYRNA
State : TN
Zip : 37167-6897
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 521 STONECREST PKWY STE 102
Second Line :
City : SMYRNA
State : TN
Zip : 37167-6897
Country : US
Telephone Number : 615-669-3128
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/14/2025
Last Update Date : 01/14/2025

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